| Project Objectives / Summary:
The aim of this project was to develop and trial strategies that enhance intersectoral action by GPs and pharmacists in the West Victorian Division that would reduce mismanagement of medications among patients and improve health outcomes in the community.
The project investigated the potential, gaps and barriers to better collaboration between GPs and pharmacists in a rural area. Strategies were developed to overcome barriers, enhance professional relationships and facilitate cooperative action to improve health outcomes in the community.
The project found willingness on the part of GPs and pharmacists to cooperate, but that there is a limited time, communication or understanding of each other's work practices and work environments.
Pharmacy needs to be championed within the Division's programs, but over time Quality Use of Medicine or Medication Management Review programs will naturally incorporate a pharmacy consultation or perspective as knowledge around pharmacy expands.
Project Outcomes:
Because the West Vic Division had participated in the RHSET project, Pharmacy in Rural and Remote Victoria, Challenging the Barriers to Rural Pharmaceutical Service Provision, it had a head start in having already mapped pharmacy services in the region and developing relationships.
To identify the shared core business and the importance and willingness of the professions to engage in activities of shared importance, a needs assessment was conducted among GPs and retail and hospital pharmacists. Common areas of interest were identified as medication use, polypharmacy, drug seeking behaviour, specific disease counselling, primary health care and health promotion.
The Project allowed for relationship building through events that invited attendance by GPs and pharmacists, and that allowed for introduction and networking lead by a GP champion who advocated for liaison, and that took place in a friendly, non-threatening atmosphere.
Relationship building was enhanced by:
- Having a pharmacist on Division staff
- Identifying an appropriate pharmacist for the Project Officer role, someone with good interpersonal skills, political diplomacy, and an advocate for the profession
- Having the active support of the West Vic Division of General Practice Board
- An understanding of the current professional and political environment
- Being inclusive of all pharmacists and GPs, eg. owners and employees, members and non-members of an organisation
- Having the budget to complete the project
The Focus Group strategy was successful. Small groups of local GPs and pharmacists were used, allowing for introductions of all participants to other local health professionals. The Focus Group event was taken to five centres, rather than expecting rural health professionals to travel long distances.
Evaluations showed that an interactive format using case studies was preferred over a didactic presentation.
The findings that pharmacy involvement in health planning was low, that pharmacist participation in inter-professional case discussions was rare, and that there was a general lack of understanding between pharmacists and other health professions made the appointment of a pharmacist on Division staff a vital first step in pharmacy advocacy. The advocacy role of the project pharmacist evolved as other Health professionals became aware that there was a pharmacist on Division staff.
The Pharmfax and the West Vic Regional Pharmacy Group have provided local pharmacists with the tools and mechanisms with which to respond with a common voice. Working Parties were used to address particular issues, one a local issue of threatened closure of a sole rural pharmacy, and the other, the difficulty for rural patients in accessing medications after hours.
A good example of successful liaison was that action through the Division, its GPs, pharmacists and the local community "saved" the local pharmacy in Dimboola. Through the project, a great deal of work was also undertaken in relation to improving after hours access to medication supply. The Chair of this working group was invited to participate on a Victorian Government reference group to progress the issue.
The pharmacist Project Officer applied for and received two small round funding grants to run consumer education sessions on the "Quality Use of Medicines" and "Asthma".
Recommendations:
The project identifies the role of State Based Organisations (SBO) and Australian Divisions of General Practice (ADGP) to continue liaison at peak body level. It emphasises the need to understand the various roles that each organisation plays.
Other recommendations highlight the requirement for continued work on medication management. In particular at workflow level, this is a systematic review of such issues as owing prescriptions, unit dose packaging and medication supply after hours.
Further recommendations encourage Divisions to commence integrated education and local pharmacy consultation in relevant program and health planning.
The project provides an extensive list of recommendations specific to QUM and DMMR; please contact the Division for further information.
Lessons / Assessment:
- To facilitate the dissemination of lessons learned, the project produced an electronic newsletter to all Divisions, and produced a "How To Kit" to encourage liaison between the two professions.
- Both pharmacists and GPs have limited capacity individually in their current work environment to reflect on work practices around intersectoral collaboration. The GP/Pharmacy Liaison project provided the opportunity to capture the thinking of both professions in a rural area, and provides the capacity to progress acceptable strategies and illustrate the benefits of collaboration.
- Referral systems and communication tools need to be developed as methods for additional communication between GPs and pharmacists. The brief phone communication and one-way written prescription communication that are currently used as communication are insufficient for GPs and pharmacists to effectively work collaboratively for improved patient management.
- The presence of a pharmacist in a Division is beneficial to facilitating a liaison role. A Division pharmacist can provide advocacy for pharmacy to the medical profession and other health professionals, raise issues of concern with the pharmacy profession, act as a stimulus for continuing education for rural pharmacists and generally promote best practice in pharmacy locally.
- For the strategy to be successful, support is needed from both the GP and pharmacy arenas. The West Vic Division Board has been supportive by allocating funding to continue work beyond the life of the funded project.
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